This section is adapted from the text “The Better Sleep Booklet” (2001) by Gwenda Cannard from Reconnexion. Click here to order a copy for yourself.
If a young person has had disruption to their sleep pattern for a long period, due to substance use or any other reason, they may not understand what is actually normal, nor what can influence their sleep patterns. Some sleep problems may be related to trauma, and so the Trauma module may also be useful for those people. Examples of other causes of sleep problems are: mood or anxiety problems, chaotic life circumstances, homelessness or unsafe housing, malnourishment, stimulant use.
There are different types of sleep problems, for example:
- Not being able to fall asleep
- Frequent waking and not getting back to sleep
- Waking too early in the morning
- Getting to sleep really late & then not being able to get up in the morning
- Worrying about not sleeping
- Waking up not feeling refreshed
Some information about sleep
For information about the ‘circadian rhythm’ and sleep / wake homeostasis, click here.
“Sleep is necessary for good emotional and physical health. Sleep ensures the proper functioning of the immune system and repair to the body” (Cannard, 2001, p.12).
People who have sleep problems can experience difficulty concentrating and less ability to cope with life and stress. They may feel irritable, oversensitive, teary and enjoy life less. Their self-esteem may be affected.
Sometimes people with sleep problems use alcohol or other depressants as they cause drowsiness, however they can interfere with natural sleep patters, worsening the sleep problems. Doctors sometimes prescribe benzodiazepines for sleep problems, which “are not actually very good at helping sleep problems in the long term” (Cannard, 2001, p.15) for the following reasons:
- Benzodiazepines are only effective if taken nightly for 2 or 3 weeks (at most)
- Benzodiazepines don’t fix the cause of sleep problem
- People can develop physical dependence, potentially leading to withdrawal symptoms
- There can be a ‘rebound’ affect when benzodiazepines are stopped, making the insomnia symptoms worse and creating the perception that the benzos are still ‘needed’
How much sleep is needed?
This varies greatly between individuals; some people cope well on five hours sleep, whereas others require 9 or 10 hours. It is important to note that during adolescence MORE sleep is needed due to increased growth and changes that are taking place. It is important to note that the first 3-5 hours provide the most restorative sleep, therefore interruptions to this part of the sleep cycle should be avoided.
Relaxation techniques at bedtime
Go to bed when you’re feeling sleepy
While there is no ‘right time’ to go to bed, when people are trying to improve their sleep patterns it is best to go to bed somewhere between 9.30-11.30pm. Be prepared for bed, and if sleepiness comes, get straight into bed rather than some other activity which can restart alertness.
Have a ‘wind-down’ routine before bed
Talk to the young person about their bedtime routine; it may be contributing to the problem. Cigarettes or caffeine-containing drinks are stimulants; or a lack of routine may prevent the wind-down.
Get up at the same time every day
This is the flip-side of a regular bedtime, helping the body form a sleep-pattern.
Eat regular meals Good metabolism can positively impact the circadian rhythm
Caffeine in coffee, tea, energy drinks & coke is long-acting and if it is hard to get to sleep it may help to cut out those drinks in the afternoon, and be realistic about overall consumption. For more information on caffeine click here.
Use Acceptance techniques to reduce the worry about not sleeping Acceptance & Commitment Therapy (ACT) teaches ‘defusion’ (see H3. Introducing Diffusion) which encourages looking at thoughts from a slight distance. In this case, it may be possible to ask ‘what is the worst that can happen (I’ll feel tired tomorrow)’.
Distract from ‘busy mind’
Whilst relaxation techniques or stress-management may be the ‘ideal’ approach to managing the busy or worried mind, it may be more accessible to the young person to listen to some of their favorite music and distract themselves for a while. If this is too stimulating there are many free Apps available that have distracting noises (from gentle music to nature sounds such as rain on the roof). This can be especially useful where the quiet of the night amplifies anxiety or worry.
Check your general health
Sometimes a deficiency in some vitamins or minerals can contribute to sleep problems, so seeing a GP or naturopath may be useful.
Sometimes the mind is exhausted but the body is not, and this can be experienced as agitation. See the Activity section of this module for information on how to increase daytime exercise or activity.
Warm drink or bath
Sometimes warm milk or chamomile tea, or a warm bath, can form a helpful part of a bedtime routine.
Encourage the Circadian Rhythm
Spend time out in the morning daylight, and make sure the bedroom is dark at night.
Once safe accommodation is established, the bedroom can be conceptualised as a ‘sleep sanctuary’. Young people may enjoy the process of considering their five senses when arranging their bedroom environment. This may include music, comfortable bed, enough warm and cosy bedding (or a fan in summer), keeping things clean and neat and smelling nice. Where possible it is better for sleep to not watch TV in bed, or even have a TV in the room, as it changes it from a ‘sleep sanctuary’ into an entertainment zone.
The Better Sleep booklet provides the following guidance:
If you don’t fall asleep in bed within 30 minutes of turning out the lights, and you find you are getting annoyed and frustrated, get out of bed and go to another room. Do something quietly such as reading or a crossword. As soon as you feel sleepy, calmly go back to bed. If you do not fall asleep, get up again until you feel sleepy once more. You will feel very tired and it will be difficult to get up in the morning. However, the deprivation of sleep will mean that it will eventually be easier for you to fall asleep when you next go to bed. Once this happens regularly, your body will associate bed with sleep and not with staying awake, making it more likely you will begin to fall asleep more quickly.
No one could say for sure what Youth AOD worker Archie put in his ‘magic tea’ but young people over the years swore black and blue that it helped them to sleep. Some said cinnamon, others nutmeg, certainly the specter of a heavily tattooed youth AOD worker fussing like an alchemist over a pot of steaming milk late in the evening was in itself as a little bit magical.
Whatever the ingredients, the small cups were accepted with interest and those who had already experienced the teas magic, re-told the bedtime story of how sleep had come to them.